Urinary tract infections (UTI) and stent-related symptoms (SRS) are frequently recognised complications of ureteric stent placement. Antibiotic administration at induction prior to ureteric stent insertion is recommended by the European Association of Urology (EAU). Commencing prophylactic antibiotics for the ‘entire stent indwelling time’ is a widespread practice among urologists despite the lack of evidence to support it. In this study the authors have prospectively analysed the benefits and drawbacks of continuous prophylactic antibiotics following ureteric stent insertion in comparison with peri-interventional antibiotics only regime. Between 2005 and 2007, 95 patients who had ureteric stents inserted for urolithiasis were randomised to either regime. UTI and SRS rates as well as antibiotics’ side-effects were evaluated. All included patients had sterile urine preoperatively and were given IV antibiotics at anaesthesia induction (usually IV Augmentin unless history of allergy). The study demonstrated an overall UTI incidence of 9.5% and the majority had SRS (at least 96%). The rate of UTI (febrile or non febrile) was not different in both antibiotic regime groups. Likewise, SRS did not differ regardless of whether continuous prophylactic antibiotics were commenced or not. As expected, gastrointestinal and skin side-effects were significantly higher in the continuous prophylactic antibiotics group. This prospective randomised study concluded that continuous prophylactic antibiotics did not reduce the rate of UTIs following indwelling ureteric stent insertion and had no effect on severity of SRS. However, this conclusion is limited only to urolithiasis patients with preoperative sterile urine.
The role of continuous prophylactic antibiotics following JJ stent insertion
Reviewed by Ayman Younis
Peri-interventional antibiotic prophylaxix only vs continuous low-dose antibiotic treatment in patients with JJ stents: a prospective randomised trial analysing the effect on urinary tract infections and stent related symptoms.
